23D-017 (4) BP-2024-1160
542 ELM ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23D-017-001 CITY OF NORTHAMPTON
Permit: Demo
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2024-1160 PERMISSION IS HEREBY GRANTED TO:
Project# 2024 DEMO GARAGE Contractor: License:
Est.Cost: 0
Const.Class: Exp.Date:
Use Group: Owner: HAYDEN NANCY L
Lot Size (sq.ft.)
Zoning: URB/WP Applicant: HAYDEN NANCY L
Applicant Address Phone: Insurance:
542 ELM ST
NORTHAMPTON, MA 01060
ISSUED ON: 09/09/2024
TO PERFORM THE FOLLOWING WORK:
DEMOLISH A SINGLE CAR GARAGE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: Footings:
Rough: Rough: House# Foundation:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: li� Z
Fees Paid: $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
_ 1,s: __ The Commonwealth of Massachusetts
'• * Fla Board of Building Regulations and Standards FOR
ll Massachusetts State Building Code,780 CMR MUNICIPALITY
�', USE
B VI g Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-FamilyDwelling
cn we g
` This Section For Official Use Only
Buildig Perm 1mberi ZO2A{-4 I to O Date Applied:
Wes,°� 1(Z
>s r172 q-a- 204
Bui4dingpflcial( rint Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Prope Address: 1.2 Assessors Map& Parcel Numbers
542 23b - Or-Ov t
1.1 a Is this an accepted street?yes ti no Map Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 —Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:�
NANCY t$�YVEp.1 1•10 .01-IPIJ,
Name(Print) City,State,ZIP
542 HAW Sr. 4G-51$-7400 fL.(SaVDO.W..D LAU).Cal
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: D ENI b LI S4 A St lJ6G CAR. t4RA40&
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 5,ADD,OD1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees:$
Check No26 ) Check Amount:50. Cash Amount:
6.Total Project Cost: $ 5/bOD.DD 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.fi.)
R Restricted I&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes 0 No 0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize srGL/41a !., Wl) GAF'i f1&4 I Pt (OAT(0 1-14-
to act on my be lf, in all matters relative to work authorized by this building permit application.
Print Ow er's Name(Electronic Signature) Aw/s0N oho of KItD (71QUSTG—e.) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
o,Y.
t er's or Au orized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.rnass.gov-dps
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics, decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
•
The Coinnit)n►vt'alth of Massachusetts
1 -_-�-_, Dt�ltrrrtntent of l�rtltistrial.-l>ccident+ 1/��111 r` 5��/�► r��t 54 . ,l
I 1 Congress Street. Suite 100 7t 3- 7
7g_602— y�
ido
Boston. MA 02114-2017 t-
s.. ww»:nlass.gov/dia
%%uikers'Compensation Insurance Ai ida.it: BuildersiContraclorsIll ctricians.''Plumbers.
'IO RE FILED%ITN riit:PERM!ITIN(;Atli itiki i' .
Annlicant Information Please Print l.rtibl
Name(Business.Organization ind►vtJuall: Sr CLAI R LAM 1>Sairri Mi E i 144D l RR i C-,hTi 61•) UL;
Address: 7,3 CA44711.1 $T V)IT to i
City/State/Zip: LPL 1A) HA-• 412 1 c>A6. Plume At:i't3 - -10'664
Are yrr on employer?Cheek the appropriate hos: fy pe of project(required):
101 am u employes with crtnptuyves 0.u11 ardor purr-tuner.• 7. ❑ New construction
:.LJ I am a sole proprietor or partnership unJ have nu employees working for the an K. Remodeling
any capacity.[No workers'comp.insurance regtured.j
9. Demolition
;.ED I am a&avows ne:doing all Houk myself.[Nu w Vrke71'cum.insurance rexputedf .
l0 Q Building addition
a.21 a a homeowner and will be hum*:sontraelurs to eundu d all wttk umnny p .Tt ru¢ y. 1 w I I.
llL.::JJJ m cure that all contractors caller fuse workers-eutnpoisat►on msunanix et an:soli 11.❑Electrical rcpain.or additions
pntpneturs w ith no employee's.
12.0 Plumbing repairs or additions
I am a IencnsI contractor and 1 bras c herd the sub-Contractors listed on the attached sheet.
These sub-contractors
pare employees and lose workers'. np.insurance.; 13.D Roof repairs
pairs
14.❑Othei
h.0 we are a corporation and to officers have exercised davit nght of exemption pet!K.L c. --�--�
IS/§1141.and we base no employees.[Aso workers'comp.insurance required.'
'Any applicant that checks box 7si must also fill out the.ioetiun below showing their wutkct.'compensation policy inionnauon.
►Ifoieow'ters who submit this aflndas-it indicating they are doing all work and then hire outside co ntrastors must submit a new affidavit indicating such.
:Contractors that check this bus must ultar:hed an additional sheet show Ing tine name of the surs-coattactors and state w liether or not those enulles base
employees- It the sub-euneractor%icase crier,fusee..the.. must pnuv ide their workers wail odic} r.Iunht.
I an:an employer that is providing workers'compensation insurance for nt:l•employees. Below is the policy and job site
information. /� 'j' t v t
Insurance Company Name: AJ--M M 4L -
Policy#or Self-ins.Lie.#: We'�•" V 1— 2#2, Expiration Date: e5- I 26
Job Site Address: 542 1"-1441&) S Ci[y Stood Lip: N� / t-Wr.
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152.i*25A is a criminal violation punishable by a fine up to S 1-500.O0
and or one-year imprisonment.as well as civil penalties in the form ot'a STOP WORK ORDER and a fine of up to S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Ins e.tigations of the DiA for insurance
co%crux verification. _
I do hereby cert ft under th ins 1 , pe of perjure'that the information provided above is Inch and correct.
� w
Sit:nature: /d ' I)a:�. " �'14
I li nc:. r
Official use only. Do not write in this area, to be cunrpletrtl by city or town official
('its or Town: Permit:License tr
Issuing,Authority (circle one):
I. Board of Health 2. Building Department 3.('ity:Tuwn Clerk 4. Electrical Inspector S. Plumbing InsltL tllr
6.Other
Contact Person: Phone#:
City of Northampton
o•''' 1 Massachusetts -.
111
. � ' 4-J DEPARTMENT OF BUILDING INSPECTIONS
' ' 14 212 Main Street • Municipal Building �ti -
���ti Northampton, MA 01060 1411,
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
686 Maki m
Location of Facility: CA5 A/ 1 SV 1 NIS1-1-614/6Ke HA"'
The debris will be transported by:
Name of Hauler: OAK 1,1\-1
Signature of Applicant: Date:
�OajHAMprp CITY of NORTHAMPTON
PUBLIC HEALTH DEPAR TMENT
keA�` Public Health Director—Merridith O'Leary. RS
0 /� Municipal Building—212 Main Street—Northampton, MA 01060
j'"i" .' Phone(413)587-1214—Fax(413)587-1221
http://www.northamptonma.gov/245/Health
Public Health
Prevent. P,-emo7e. Pi O:eet.
WITNESS OF EXTERMINATION
Date Time jl : 1 .
Property Owner: ki,cn xf. . 46_10 CI G
(.011 A.J. �'D-fA�OM P N
Property Address: .'• Lf 1 ' r-- =--7 :4--
Exterminator: 4 _G ,-r�
Company: M L .r k 'RQ b r L'a„n.fira I
Company Address: 12 f e--fri)- Ln p. I ba-ny 12z_o 5- c-i -gkoq"
-l37�
Rodenticide/Chemicals Applied I1 _
Reason for Extermination: 1) &A1246,6
Comments: 5 C'r Z. art& C-he-e
I hereby certify, under the pains and penalties of perjury,that I to the best of my knowledge
and belief, have applied the above noted pesticide in accordance with M.G.L. Chapter 132B
and any other applicable law or regulation.
Lid City Water ill, ),•I ti stem
If applicable ❑Yes ❑ No
.l.lza1 eA
Board of Heal Representative Signature of Exterminator
*Demolition best practices relating to fugitive dust and debris must be adhered to in accordance
with MGL Chapter 111, Section 122.
Meerkat Pest Control Service Report
12 Petra Ln #1
TMEERKAT Albany, NY 12205
12 Petra Ln#1 Albany, NY 12205 518-869-7378 ORDER #: 333690
WORK DATE: 09/05/2024
Time In: 09/05/2024 11:44:55 AM
BILL-TO 162221 LOCATION 162221 Time Out: 09/05/2024 11:58:52 AM
St.Clair Landscaping and Irrigation St.Clair Landscaping Customer Signature
William H.St.Clair Sr. Bill St.Clair
8 Blacksmith Rd 542 Elm St
Wilbraham, MA 01095-1312 Northampton,MA 01060-2832
Customer Unavailable to Sign
Phone: 413-478-0027 Phone: 413-478-0027 Technician Signature
Mobile: 413-478-0027 Mobile: 413-478-0027
Myles Ierardi
License#: MA-1779268
MA-AL0051290
MA-N262
Purchase Order Terms Service Description Quantity
None DUE UPON RECEIPT PEST INSPECTION 1.00
TECHNICIANS
Myles Ierardi
License#:
MA-1779268
MA-AL00S1290
MA-N262
GENERAL COMMENTS/ INSTRUCTIONS
Completed inspection of the detached garage at 542 Elm St.in Northampton MA.
There were no current findings of any active rodents in the building.
PRODUCTS APPLICATION SUMMARY
None Noted.
Printed:09/05/2024 Page: 1/1